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    <s:form action="sellerpaisapay" method="post" enctype="multipart/form-data" name="form1" id="form1">
    
    
         
          <p align="left"><span class="style14">Register To Sell With Paisa Pay </span></p>
          <p>&nbsp;</p>
          <p align="left"><img src="images/1.gif" width="135" height="70" /><span class="style17"> Register now and offer buyers the assurance of Paisa Pay </span></p>
          <p align="left">&nbsp;</p>
          <p align="left">&nbsp;</p>
          <p align="left"><img src="images/2.png" width="838" height="163" /></p>
          <p align="left">&nbsp;</p>
          <p align="left">&nbsp;</p>
          <table width="839" height="732" border="1">
            <tr>
              <td colspan="2"><p class="style20">PAISA PAY REGISTERATION DETAILS <span class="style21">(INCORRECT DETAILS)</span> </p></td>
            </tr>
            <tr>
              <td colspan="2"><p>&nbsp;</p>
                  <p class="style19">PaisaPay requires your bank details to regularly send you the payments you   receive from your buyers. These payments are transferred online to your bank   account, so you face no hassles or security risks in receiving your money.</p>
                <p class="style19">Please procvide the bank account details list </p></td>
            </tr>
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              <td width="137" height="44">PAYEE NAME </td>
              <td width="686"><label>
              
              
              
               <s:textfield name="payeename" theme="simple"/>
                
                
                
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              <td height="42">BANK ACCOUNT NUMBER </td>
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               <s:textfield name="accntno" theme="simple"/>
                
                
                
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              <td height="38">BANK NAME </td>
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               <s:select name="bankname" theme="simple" list="{'Axis Bank','American Express Bank','CitiBank','HDFC Bank','Punjab National Bank','State Bank Of India','Indian Bank','Bank Of India','ICICI'}" />
                
                
                
              </label></td>
            </tr>
            <tr>
              <td height="37">CITY</td>
              <td><label>
              
              
                <s:select name="city" theme="simple" list="{'Allahabad','Bangalore','Chandigarh','','Chennai','CitiBank','Delhi','Ghaziabad','Jaipur','Kota','Luckhnow','Mumbai','Surat','Udiapur','Vellore','YamunaNagar'}" />
                
                
                
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              <td height="39">BRANCH</td>
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             <s:select name="branch" theme="simple" list="{'Sector-27','SCO-897','Sector-45','Behind Main Market,sector-17','Sector-19','Sector-47','Sector-12'}" />
                
                
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              <td height="43">MICR CODE </td>
              <td><label>
              
              
              
              
                <s:textfield name="mcir" theme="simple"/>
                
                
                
                (
              9 digit code found at bottom of your cheque ) </label>
                <div></div></td>
            </tr>
            <tr>
              <td colspan="2"><p>&nbsp;</p>
                  <p class="style20">PAISA PAY  SELLER TERMS AND CONDITION </p></td>
            </tr>
            <tr>
              <td colspan="2"><p>
                  <label>
                  
                  
                  <s:checkbox name="agree" theme="simple"/>
                  
                  
                  
                  
                    That by clicking </label>
                on the box i agree that I have read and understood <a href="#">PaisaPay Seller Terms And Conditions</a> and unconditionally accept to be legally bound by the following:</p>
                  <div>
                    <div>
                      <div>
                        <div>
                          <div>
                            <div>
                              <div>
                                <div>
                                  <ul id="agreement">
                                    <li>That I have had reasonable opportunity and time to read, understand and take   proper advice;</li>
                                    <li>That while using PaisaPay services, I unequivocally agree &amp; undertake to   abide by and comply with the Seller Terms &amp; Conditions,</li>
                                    <li>I further agree that the Seller Terms &amp; conditions are in all respects   fair, reasonable and nesessary in order to protect the users of PaisaPay   services and the legitimate business interests of PaisaPay;</li>
                                    <li>I understand that the information I provide will be collected by PaisaPay   (or its succesors and assigns) and stored and processed in accordance with   PaisaPay Privacy Policy;</li>
                                    <li>I agree that PaisaPay is only a service provider and is not responsible for   any non-performance or breach of contract between users of   PaisaPay.</li>
                                  </ul>
                                </div>
                              </div>
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                <p>&nbsp;</p>
                <p>&nbsp;</p></td>
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